My guest is cardiologist Dr. Luis Pagan-Carlo speaking about the importance of having one of the most challenging conversations physicians must have in medicine today – helping patients talk about their thoughts and feelings about living with their illness when there is no further medicinal or surgical remedy available. 

Patients and physicians alike tend to avoid it. And yet both strive for a way to have a real conversation about the reality of their illness and the limits of medical intervention. 

Dr. Pagan-Carlo explores the various factors that help contribute to this "conspiracy of avoidance” and suggests that we - patients and their families as well as the medical community - need to devote attention to having these conversations in a straightforward, compassionate manner. He believes that patients and families are yearning for such a real dialog and are deeply appreciative of that opportunity. And that while it seems to fly in the face of the conventional practice of referring patients for one more procedure or med trial, a thoughtful and informed dialog really goes to the heart of what it means to be a physician. 

"The good physician treats the disease; the great physician treats the patient who has the disease." ~ William Osler 

Sexual harassment is a very significant problem in healthcare.

My guest is Animah Kosai, a lawyer by training who has extensive experience in organizational ethics and compliance. 

Seeing the need to help individuals in organizations victimized by sexual harassment or punished for their whistleblowing, Animah was inspired to start Speak Up At Work to empower employees to understand the processes and develop the skills to come forward to uphold their rights and hold wrongdoers accountable. As former general counsel for a large multinational oil and gas firm, she also recognized the need that organizations themselves have to create healthy organizational cultures which are in fullest compliance with law and which foster  environments of respect and inclusion.

There was a  piece posted in the popular physician-oriented website KevinMD.com by an anonymous physician entitled "I’m sorry: Why I lost my love for medicine.” Understandably, it generated a significant amount of comments and shares. But, as is the way with so much on the web, it’s very easy to miss some really important essays. And I didn’t see it until someone shared it with me only a month ago on the heels of a discussion we’d had about burnout, one of my key areas of interest. 

As I read it, I identified immediately. It conveyed the sense of being overwhelmed, bombarded, put in no-win situations, taking in so much demand and negativity and feeling demoralized, exhausted and seeing no way through, and the only option being “out.”  I read it out loud to myself, once, and then again, and again. In fact, it so deeply resonated that I got choked up as I read it. And since I have coached many physicians grappling with burnout, I felt that it might be helpful simply to do a dramatic reading as part of a podcast introducing the topic of burnout. Clearly, it’s one of the major reasons why physicians' careers get “interrupted.” 

Roughly 50% of physicians today are grappling with some element of burnout. There’s a pervasive sense of dissatisfaction across all age ranges and specialties. Worse, because of the malignant ways medical boards invade physicians’ privacy and compel referral to a non-overseen “physician health program” enterprise from which there is abundant evidence of psychological abuse, physicians are inclined  to avoid seeking help and , should they pursue help, to attempt to conceal it from their peers, their employer and certainly from their medical board and PHP. 

As a result, demoralized and burned out physicians are leaving the field, and encouraging others not to enter it. If they don’t get help with their burnout, it may deteriorate into an emotional illness like depression or, if depression or anxiety was already present, greatly intensify it. And untreated, whether for fear of stigma or  opportunistic and traumatic handling by one’s medical board, peer review / performance appraisal entity or the PHP,  the risks of disabling outcomes are greatly increased. And that is such an unfortunate loss. 

I know this will be one of many visits to the topic of burnout. I welcome hearing your thoughts.

(see: https://www.kevinmd.com/blog/2019/07/im-sorry-why-i-lost-my-love-for-medicine.html) 

In Part 2 of Questionable Drug Testing, host Dr. Kernan Manion continues an amazing conversation with Dr. Michael Langan, author of the blog DisruptedPhysician.com. Michael has intensively studied the PHP (physician health program) movement and its 47 state programs’ use of inappropriate alcohol biomarker drug testing in assessing physicians referred for the question of substance abuse-related occupational impairment. The EtG urine test as well as others routinely used by PHPs are known to produce false positive results. Use of these tests in such a forensic environment was strongly advised against by SAMHSA, the US Substance Abuse Mental Health Services Administration, specifically because such alcohol biomarker tests were KNOWN to have a very problematic incidence of false positivity. However, these test results are still routinely being used to mandate compliance with PHP’s incontestable diagnosis of definitive alcohol abuse and its  “recommendation” to the medical board (MLB) that the physician immediately cease practice and go to a PHP-network facility out-of-state at exorbitant cost under threat of loss of license and public humiliation.  These tests were never intended to answer the question of “occupational impairment” or even to establish a diagnosis of “substance dependence,” and yet PHPs portray as much to the MLB and to the rights-deprived physician and his/her counsel who naively accept this as established scientific proof.  The physician is deprived of any recourse to contest. As presented, there would be little doubt that such a knowingly wrongful process is equivalent to fraudulent diagnosis. The consequences for the wrongfully charged physician are dire.  

(Due to the length of the original interview and its immense importance, the podcast was divided into two separate podcasts. This is Part 2.)

If you’re a physician, physician’s counsel or simply interested in a deeper exploration of the specifics of the ill-advised use of such tests, the harms that may ensue and potential approaches to confronting this wrongdoing, be sure to visit [https://www.physicianrights.net/drugtestwebinar] to be notified of our upcoming free live webinar specifically devoted to more deeply understanding these harmful practices and what you can do to defend your rights. We’ll send you the Zoom webinar and Facebook Live logistics as soon as they're finalized.

Host Dr. Kernan Manion talks with Dr. Michael Langan, an internist / geriatrician formerly with Mass General Hospital and now a consultant, researcher and author of the blog DisruptedPhysician.com. Michael has intensively studied the PHP (physician health program) movement and its state programs’ use of highly questionable drug testing in assessing physicians referred for the presence of substance abuse related impairment. He reveals that one or more of the urine tests routinely used by PHPs are known to produce false positive results. Further, use of these tests in a forensic environment was strongly advised against by SAMHSA, the US Substance Abuse Mental Health Services Administration, specifically because such alcohol biomarker tests were known to have a very problematic incidence of false positivity (due to high sensitivity but low specificity). Worse, these test results were then being used to mandate compliance with PHP’s “recommendation” to the medical board (MLB) that the physician immediately cease practice and go to a PHP-network facility out-of-state at exorbitant cost under threat of loss of license and public humiliation.  And these tests were never designed as an assessment of “impairment” or “substance dependence,” and yet this is what the PHP is portraying to the MLB and to the rights-deprived physician and his/her counsel. Worse, once accused, due to a complete absence of due process, the physician is deprived of any recourse to contest. (Due to the length of the interview and its importance, the podcast was divided into two separate podcasts. This is Part 1.) 

If you’re a physician, physician’s counsel or simply interested in a deeper exploration of the specifics of the ill-advised use of such tests, the harms that may ensue and potential approaches to confronting this wrongdoing, be sure to visit [https://www.physicianrights.net/drugtestwebinar] to be notified of our upcoming free live webinar specifically devoted to more deeply understanding these harmful practices and what you can do to defend your rights. We’ll send you the Zoom webinar and Facebook Live logistics as soon as they're finalized.

Excited to give you a heads up about an upcoming podcast on Physician Interrupted. 

Confronting Questionable Drug Testing in PHPs. 

Very pleased to have as my guest expert Dr. Michael Langan who’s extensively studied the use of highly suspect alcohol biomarkers in PHPs. What he reveals is that not only are there very serious questions about the appropriateness of these tests for PHP intake screening purposes, their false positive rate may be wrongfully sending physicians to costly in-network evaluation and treatment centers. Worse, it appears the PHPs and the medical boards know these tests are both known to produce false positives and their use has in fact repeatedly been strongly advised against by at least one federal health agency. Dr. Langan suggests that what we’re really looking at is a massive scheme of intentionally fraudulent diagnosis. This will be one you don’t want to miss. 

Various forces can adversely impact a physician's career. However, that unseen entity - the Medical Regulatory Therapeutic Complex (MRTC)  consisting of the regulatory entities that hold life-and-death power over a physician’s career -  is one that is both the least understood but the most potentially dangerous riptide that can literally end one’s career with no recourse. Few are aware of its pervasive presence, much less of its potential career lethality. And that’s why it’s vital for physicians to understand what it is, how it works and what you can do to navigate this perilous territory.

Here, we explore the 10 Commandments for surviving a career riptide in this environment.

Perhaps the two most important are #1 and #10. Know that this extremely dangerous threat exists; and prepare fully to steel yourself for the ordeal, preparing thoroughly and following a well-thought out strategy while also keeping yourself in balance and not going over the rails.

Here’s a link to the 10 Commandments handout for quickie refresher:  https://www.physicianrights.net/podcast_ep3

This episode of "Physician, Interrupted” examines the “career riptide” phenomenon that occurs via unfair use of licensing,  credentialing and "clinical privileges" power that can abuse physicians’ rights with impunity. We begin to explore what you can - and must - do to protect your rights as a physician against unwarranted career disruption.

Imagine that you're walking along the beach enjoying yourself calmly strolling and you see a little puddle and you step in the puddle not aware that it's actually part of a receding tidal pool. And that tidal pool suddenly pulls your feet out from under you and you are swept out to sea in a riptide. Those who know about riptides know that a person's first response if caught in one would be to try to keep your head above water and then  turn around and swim directly back to shore. This is invariably futile as it exhausts the swimmer because you don’t have the strength to swim against that powerful tide, so you get exhausted and then drown.

There are various dangerous riptides in physicians’ careers. Malpractice suits are the type that most physicians would identify with. However, one many physicians are not aware of is the riptide driven by an unseen medical regulatory complex which has life-and-death power over your career. That complex consisting of state medical licensing boards, state physician health programs (or PHPs), institution-based peer review committees and departmental performance appraisals are each immensely powerful entities which generally work in sync and whose non-overseen and non-accountable deliberations can irreparably destroy a physician’s career and deprive them of their license and livelihood. 

We cover 3 immediate action steps you must take to protect your career. In the next podcast, we cover the “10 Commandments” for survival in these matters.

"Physician, Interrupted” is a weekly podcast hosted by Dr. Kernan Manion, an MD physician and psychiatrist by specialty who retired from clinical practice about 7 years ago to devote full-time to consulting, coaching, writing and speaking.

"Physician, Interrupted”  focuses on the burning issues facing physicians today and the challenges  they face in their careers as clinicians and healers, indeed challenges to their physicianhood itself.

Physicians are under incredible stress today from a tsunami of forces. And that stress is taking a toll. Burnout is reported as high as 50% of practicing clinicians. Physicians are facing immense scrutiny and experiencing extraordinary hassle in practicing their craft.

What’s happening to physicians - and to so many others in healthcare today - is deeply concerning.  

Healthcare as a service industry is undergoing chaotic reorganization. As a consequence, the trained professionals who actually do the healthcare work, and here we’ve chosen to focus on physicians though in many ways the podcast is really relevant to all healthcare professionals, are being tossed about in this tumultuous storm. The very nature of physicianhood and healing is being questioned.

“Physician, Interrupted” hopes to address all aspects of the forces at work which adversely impact physician wellbeing, forces that can even shipwreck effortfully obtained careers.

We’ll be covering a host of relevant topics that help bring a deeper understanding to the state of physicianhood today and the forces which impact it.

We’ll devote significant attention to a particular area of growing concern, that of physicians rights, to fairness, to speak up, to a reasonably balanced life, to pursue their love of medicine without unwarranted intrusion. 

And, just so that you know that you don’t have to load up on antidepressants before listening, it’s not  going to be Debbie Downer whiner show about how impossible or awful physicianhood has become. In fact, we’re going to be talking about joys and fulfillment as a physician, and remedies; about recrafting your physicianhood; and about actively participating in redefining our role in the evolving healthcare system and healing the very culture of medicine itself.

“Physician, Interrupted” welcomes your joining the conversation, your feedback, and suggestions and corrections. And if you’ve got a burning topic you want the podcast to explore, even better with a guest you have in mind, please let me know.